Paul Hofman: Paediatric Endocrinolgist talks New Zealand's high use of puberty blockers

A view that puberty blocker use for trans youth in New Zealand needs tighter supervision. 

New Zealand's use of puberty blockers is seven times higher than comparable countries. 

Paediatric Endocrinologist, Paul Hofman says they shouldn't be banned as they can be effective in some cases. 

He told Heather du Plessis-Allan it's not settled science. 

Hofman says the evidence for puberty blocker's efficacy is not as strong as many think.

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Episode Transcript

Speaker 1 (00:00):
Now on another subject altogether, We've got a bit of
an insight today into the use of puberty blockers for
transgender kids in the country. Analysis in the Medical Journal
shows that New Zealand doctors have been prescribing these puberty
blockers up to seven times more than in other comparable countries.
And comparable countries we're talking about are the Netherlands, England, Wales,
Denmark and so on. Now. Professor Paul Hoffman is a

(00:22):
pediatric endocrinologist at Auckland University.

Speaker 2 (00:24):
Hey, Paul, Hi, does that.

Speaker 1 (00:26):
Surprise you how often these things have been prescribed here?

Speaker 2 (00:31):
Not particularly, it's there has been a trend in New
Zealand probably to use more pupil suppressive therapy than other
parts of the world. I am surprised at the absolute amount,
but I have to say we have to be a

(00:52):
bit careful because the study wasn't precisely looking at pubertal
suppressive therapy per se, but at the number of prescriptions
drived for pupil suppressive therapy. And that's not just transgender.
There's other conditions involved in that as well, So.

Speaker 1 (01:07):
That tends to be in the under twelves right in
the twelve to seventeen or twelve to eighteen category that
will mainly be transgender, won't.

Speaker 2 (01:13):
It will mainly, but there are a number of particularly
for males, not so much females, who will be still
beyond on therapy during that stage. So I do agree
that the rapid increase is almost certainly related to transgender.
It would be really nice so to have that accurately defined.

Speaker 1 (01:29):
Now, why has it been happening at such a rate
in New Zealand? Do you have any idea?

Speaker 2 (01:33):
Well, I think two things first before we get to that.
First there, we've just got to be careful the rates overseas.
They are probably closest to accurate in the Dutch. But
when you're doing things one hundred thousand adolescents and it's
not national data, which it is in this country, you
are approximating the background population, so the denominator may not

(01:56):
be entirely accurate, so there is potential bias both could
make it higher or lower. So I think we had
to be a little careful as well. But yes, I
think overall it's definitely higher compared to you just looking
at what's happened in New Zealand over the last decade,
and it probably is a lot higher than what's happened
in Europe, at least two to three European countries. Now, well,

(02:17):
that's a good question. I think it reflects the approach
to transgender in New Zealand, which goes on a human
rights perspective where it's a human right to decide what
your gender is, as opposed to an evidence based approach
where we're looking at evidence that the therapy is effective
and making sure we're using it appropriately. And that's what's

(02:40):
been happening, particularly in Europe and the UK, where there
have been a number of problems and older youth and
young adults which who wanted to wanted to change back
and they've already had permanent surgery. So I think there
has been a concern that it's been overused whereas and
so they've gone down a more evidence based approach, and

(03:02):
I have to say the efficacy of the actual hard
evidence that it has benefit is not as strong as
we'd like to think it is. There are clear cases
where it does, but it's not as clear colors as
we as we used to think.

Speaker 1 (03:14):
So quite interesting in that data, it appears that the
use of the puberty blockers prescriptions have started to decline
in the last couple of years. Now, do you think
that is because we have increasingly in the last couple
of years talked about this stuff and talked about the concerns,
and so parents and perhaps doctors are sort of just
getting a bit worried about prescribing.

Speaker 2 (03:35):
Yeah. Look, I think there has been increasing data internationally
and concern those in the scientific media but also in
the press expressing the worries about using this therapy, and
so I think there has been reduction. It's also possible,
of course, that we've saturated the number of kids with

(03:56):
transgender and use of transgender out there, so that there
the population is now stabilizing. Well, I suspect as you
say that, it's more likely it's there is a negative
or concerning impact on the effect of pupil suppressor therapy
and it's and its benefits.

Speaker 1 (04:12):
Paul, do you think that we should go down the
same path as Britain and ban the use of puberty
blockers for under eighteen's the routine use.

Speaker 2 (04:20):
My personal feeling is no, that's basically partner on some
of the clinical cases I've been involved in. I don't
generally do transgender children look after transgender children myself, but
I have been involved in several cases where I have
seen benefit. This is a very vulnerable group and I
think those who are self harming or doing high risk behaviors,

(04:41):
if you have a therapy which can reduce those reduce
some of that stress, then I think that it's not
unreasonable to look at it. So whilst I don't think
it should be banned, I think that close supervision and
careful use of it, particularly with the use of a
psychologist and a multi discipline team, is very important.

Speaker 1 (05:00):
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